Corticosteroids and adrenal suppression. Characterising and avoiding the problem

Glucocorticoids are used for a variety of illnesses. One of their major complications is suppression of the hypothalamic-pituitary-adrenal axis, rendering a patient unable to respond to stress. The risk of this suppression may be minimised by the use of short-acting glucocorticoid preparations, administration of the entire daily dose in the early morning, use of topical and intra-articular preparations where appropriate, and the use of alternate-day therapy where appropriate. Most importantly, glucocorticoids should be used cautiously when indicated, and the duration of therapy limited as much as possible.